Screenings and Immunisations – Trust and communication in the health service

A recent meeting about screenings and immunisations got me thinking about the interaction of the health service with vulnerable people and groups. Broadly speaking this was a useful event for all, both for those with a medical or community interest. It does seem that we as a country are relatively strong in the uptake and coverage of immunisations against countless diseases and effective screening against various conditions. There are exceptions however.

Notably, the gaps in take-up are most often those with certain characteristics, such as mental health difficulties, and come from vulnerable or isolated groups. Other examples include asylum seekers, sex workers, children in local authority care and prisoners. Despite the great variation amongst these people, the common theme is about engagement with the health service or rather the obstacles to this. Put simply, those with less positive interaction with surgeries, health visitors, hospitals etc. are less likely to know about, understand, trust or in practice get access to immunisations or screenings.

For the Gypsy and Traveller community there may be a combination of these factors, of both practical barriers in getting access to healthcare and emotional barriers and wanting to engage with it. I stress may because of course the situation will vary for all and our members will have lots of difference experiences. There are common themes however and ones which are shared with other vulnerable groups, including difficulties in getting access to a GP, receiving relevant health messages and health literacy.

It is easy to see the connection between these challenges and immunisation or screening take-up. If you do not have, or struggle to build a relationship, with a GP then getting access to immunisations, let alone getting reminders or follow up calls, is near impossible. Equally, if your experiences with health services, whether the surgery receptionist or hospital doctor, have been less than positive then it is easy to see how important health messages, if you are receiving them at all, would be dismissed, mistrusted or ignored.

Much of this comes down to communication. Surgeries who know their patients and want to engage understand various language or literacy barriers and make efforts to tailor their messages accordingly. Pleasingly, I met a number of medical staff who recognised their role in engaging with more vulnerable patients. Sadly, this is obviously not always the case and many of our members experience great difficultly accessing information which would allow them to make informed choices. Doubtless this will similarly be the case for many other vulnerable groups and individuals.

Immunisations and screenings represent a good example of a wider challenge; to improve the communication of health messages between medical professionals and vulnerable communities. We and our members are often best placed to help one another, precisely why there is a need for services to enable an 'inreach' approach. It is critical to ensure that vulnerable community members are made particularly welcome in healthcare settings, not just as patients but also as 'expert patients'. If they can be assisted to be active in the service governance, design and delivery, such as for immunisations, everyone benefits.